How effective are different models of pelvic binders: results of a study using a Pelvic Emergency Simulator

Uwe Schweigkofler, Dennis Wincheringer, Jörg Holstein, Tobias Fritz, Reinhard Hoffmann, Tim Pohlemann, Steven C Herath

Eur J Trauma Emerg Surg 2020 May 26;Online ahead of print

Background: The application of pelvic binders in the preclinical and early clinical phase is advisable to avoid or treat C-problems in unstable and potential bleeding pelvic ring fractures, even if the clinical effectivity is not completely proved. The use for pathologies in the posterior pelvic ring is still debatable.

Questions/purposes: We determined if there is a difference in achievable compression in the dorsal pelvic ring depending on position and pelvic binder model. Can this effect be tested with a simplified artificial model?

Methods: We simulated a Tile type C fracture within the established pelvic emergency trainer and measured in a test series the effectivity of reduction with a non-invasive stabilization technique using 3 different pelvic binders.

Results: Any therapeutic effect of a pelvic binder with compression to the posterior pelvic ring requires at first a reduction maneuver. While the compression effect in the symphysis depends only on positioning of the binder, in the posterior pelvic ring, the result varies with the used model. The achievable pressure in the SI joint with a pelvic binder is only 20-25% (33.5-47 N) compared to the C-Clamp values (156 N).

Conclusions: The use of pelvic binders for non-invasive pelvic ring stabilization, even with a posterior pathology, could be proven in a simplified fracture model. A proper fracture reduction and an adequate device positioning influence the effectiveness.

Clinical relevance: The use of an emergency pelvic trainer even for a non-invasive maneuver is advisable.